JAMA

doi: 10.1001/jama.1976.03260460003001pmid: N/A

Prostaglandin analogue device used for inducing abortions Abortion can be induced successfully during the first and second trimesters of pregnancy by a newly developed intravaginal device of silicone rubber that contains a prostaglandin analogue. The disk-shaped device is impregnated with 11 mg of 0.5% 15 (S)-15-methyl prostaglandin F2α methyl ester. It has a surface area of 20 sq cm and is approximately 0.2 cm thick and weighs 2.2 gm. The device is inserted high into the vaginal vault (without prior cleaning of the vagina), followed by a tampon to prevent expulsion. Patients are kept in a supine position for at least 30 minutes. This new method of inducing abortion is being studied by Niels H. Lauersen, MD, associate professor of obstetrics and gynecology and Kathleen H. Wilson, a research assistant, at the New York Hospital-Cornell University Medical College in New York. At the Las Vegas meeting of the

doi: 10.1001/jama.1976.03260460009002pmid: N/A

The "Mayo wrist" prosthesis described in a recent issue (JAMA Medical News 235:1316 [March 29] 1976) should be called the "Meuli wrist," after Hans Cristoph Meuli, MD, of Bern, Switzerland, who developed the device. The Medical News article describes the use of the device at the Mayo Clinic.

Liddle, G. G.

doi: 10.1001/jama.1976.03260460012003pmid: N/A

To the Editor.— During the winning of the West, bounties were frequently offered for the heads of villains, dead or alive. As suggested in Bierce's Devil's Dictionary, bounties were prompted or supported, or even paid, by insurance companies, for which Bierce entertained woeful disrespect. This led to my great uncle Gregory's Third Law of Liddle, "Whither there shall be a bounty proffered, there shall be a hunter thereof, or two." Honoring this major contribution to the humanities, the hunters lined up in echelon. Often viewed as renegades, disreputably motivated by size of the bounty, they were really noble citizens, merely dedicated to the purification of society. Within the purviews of ordinary men, the purlieus of the bounty hunter now embrace those fields of corporate medicine that involve readjustment of limb, transmutation of golden brain to alchemical slush, and cutting up generally. Although bounty sizes seem inflationary, one must remember that

ROTKIN, I. D.

doi: 10.1001/jama.1976.03260460012004pmid: N/A

To the Editor.— Before we conclude that "The long smouldering suspicion that genital infection with herpes simplex virus type 2 [HSV-2]... carries with it an enhanced risk of cervical cancer... has now become a virtual certainty" (234:1101, 1975), we should examine the accrued evidence. There is more in the literature than the two sources cited by your reporter, much of which is far from secure when reviewed. Tabulated comparisons of collected seroepidemiologic studies have recently become fashionable, and although their purpose has been to provide persuasive reason for the belief that HSV-2 is the oncogenous agent (or one of the agents) as I predicted in 1962,1 they all have features in common that tend to emphasize the difficulty some of us have in accepting the neatness of the HSV-2-cervical cancer risk relationship espoused in the report. One such summary, presented by Nahmias et al,2 at a symposium in

Weintraub, Michael

doi: 10.1001/jama.1976.03260460013005pmid: N/A

To the Editor.— Some critics of excessive participation of the "poor" in medical experiments have suggested prohibition of their use in such studies ("poor" defined as prisoners, students, and patients attending the clinics of teaching hospitals—in short, populations "deprived not only for strictly economic reasons, but also because of social, cultural, administrative, and political factors"). In their place, others not disadvantaged or dependent would participate. To ensure equality of opportunity, computer techniques would be used to select potential volunteers for studies. Other prohibited groups would be those thought by some to be unable to offer true informed consent, eg, children, the aged, soldiers. As I dozed over the discussion of these issues, an insight into the future unfolded before me: Employment Manager: Good Morning, what can I do for you? Applicant: I'd like to apply for the job you advertised in the paper. Employment Manager: Very well, may I have

Galland, Leo

doi: 10.1001/jama.1976.03260460014007pmid: N/A

To the Editor.— The advice of your consultant, Paul Wehrle, MD (234:430, 1975) that non-group A β-hemolytic streptococci are not respiratory pathogens is probably incorrect. While there has been no evidence to link these organisms with acute rheumatic fever or glomerulonephritis, there is considerable reason to suspect them of being primary respiratory pathogens. Glezen et al1 found a 10.8% frequency of non-group A streptococci in the pharyngeal cultures of college students with sore throats and a 0.2% carrier rate in asymptomatic students. Nine of 42 students with non-group A streptococcal pharyngitis showed a rise in antistreptolysin O titer when paired sera were examined. No mention is made of the treatment these students received. Mogabgab2 found a similarly high incidence of non-group A streptococcal pharyngitis in adults, and often found these organisms to be present in very high titer. I have reviewed the results of 300 consecutive throat cultures

Melamed, Myron

doi: 10.1001/jama.1976.03260460014006pmid: N/A

To the Editor.— I read the article by Dr Brewer entitled "Guidelines for Recertification" (235:725, 1976) with a sense of scientific indignation. Nobody has ever established that reexamination by any method has any correlation with quality of patient care.There is also significant question as to whether routine postgraduate study to obtain a certain number of "points" has any value in this regard.The logistics for routine postgraduate education are mind-boggling when one considers the cost involved in physician time and expenses for a few hundred thousand doctors.One can seriously question who should be the examiner and the examinee when physicians of considerable experience are involved.It would seem that a medical audit system for physicians in hospital practice would determine the presence or absence of quality patient care when physicians are judged by their peers of departmental committees. This could be done in

Cohen, Arthur H.

doi: 10.1001/jama.1976.03260460014008pmid: N/A

To the Editor.— Luft et al in their report (234:1158, 1975) relate the finding of renal vein thrombosis to the massively obese state of the patient described. Although they discount primary renal disease antedating the vascular complications, it seems more plausible to invoke a mechanism not considered by them in detail. The authors describe "basement membrane thickening" and "membranous glomerular changes," but illustrate this with a hematoxylin- and eosinstained photomicrograph. Detailed observations with other stains, eg, periodic acid-methenamine silver (Jones), Masson trichrome, periodic acid-Schiff, are not reported, so that it is not possible to determine if, indeed, the alterations of the glomerular capillary wall are due to the presence of immunoglobulin deposits and the accompanying basement reaction ("spikes"), typical of membranous nephropathy, the result of considerable basement thickening, or another process. Many factors permit more than idle speculation that an underlying membranous nephropathy would explain this patient's course. (1) This

Foy, Hjordis M.

doi: 10.1001/jama.1976.03260460015009pmid: N/A

To the Editor.— During the last couple of years, leading American journals have lamented the poor education and training of foreign medical graduates.1-4 The superior accomplishments of American medical science is also attested to in the large number of Nobel prizes awarded US citizens in medicine and physiology (35 laureates since the end of World War II). But, surprisingly, 13 (36%) of these awards went to naturalized citizens, who had received the major part of their scientific education on foreign soil, mostly central Europe (Encyclopaedia Britannica and recent press releases). Furthermore, at least two Americanborn laureates (Watson and Ward) went to Europe for special training and research. Admittedly, most of these Nobel laureates were not practicing physicians, but biochemists and physiologists not subjected to the ubiquitous Educational Council for Foreign Medical Graduates (ECFMG) examinations and Federation Licensure Examinations (FLEX), which reflect American curricula, norms, and proficiency in English. Regardless,

Harris, Benjamin K.

doi: 10.1001/jama.1976.03260460015010pmid: N/A

To the Editor.— We noted with interest the report by Goldenberg and Gibbons (235:284, 1976) of seropositive rheumatoid arthritis and HLA 27. We would interpret the clinical and laboratory studies to indicate that the patient had inflammatory bowel disease with spondylitis, and that rheumatoid arthritis subsequently developed. While it is unusual to see seropositive rheumatoid disease with nodules and few articular findings, such cases have been described.1 We have recently seen a 44-year-old man with a history of Reiter syndrome diagnosed in 1961. In June 1975, he had asymmetric, painful swelling involving the wrists and the metacarpophalangeal and proximal interphalangeal joints. The patient was initially thought to have an exacerbation of Reiter syndrome, although there were no genitourinary, mucocutaneous, or ocular manifestations. He had positive reactions for HLA W27 (B27 according to the newer nomenclature), and his latex test for rheumatoid factor was positive in a dilution of 1:1,280.